Project description

Regulatory pressure is considered a big problem in elderly care as well as in other care sectors. It is felt that regulatory pressure stands in the way of personalized care as care workers have to spend too much time on registration and lack the flexibility to deviate from rules and regulations in order to provide care according to the wishes of their clients. It is therefore argued that regulatory space is needed to improve quality of care. In this project we studied this subject by answering the following research questions:

What does regulatory pressure in elderly care consist of?

What problems does regulatory pressure pose for providing personalized care?

How can regulatory space be created in such a way that more personalized care can be provided and public accountability can be ensured?

We conducted literature reviews on the care relationship in elderly care, regulatory pressure in health care and regulatory space. For the latter we used insights from literature on positive deviance and experimental governance. In addition we conducted interviews with actors in the Netherlands involved with the subject of regulatory pressure and observations of discussions on this subject. In addition we conducted qualitative case studies in four elderly care organizations.

Our study shows that regulatory pressure is a complex problem; rules have many sources and there is a lot of unclarity about them. Furthermore, these rules can conflict with wishes of clients thereby standing in the way of personalized care. However, this does not mean that these rules can just be discarded as care workers and care organizations are also responsible for quality and safety which certain rules are meant to ensure. Therefore health care workers and organizations can be confronted with dilemmas on what should be considered good quality care. Our study provides lessons on how health care organizations and other actors in elderly care can deal with these dilemmas by working on quality and giving account of quality in a more reflexive way.